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Cognitive–behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial

Published online by Cambridge University Press:  21 September 2016

C. Steel ,
A. Hardy ,
B. Smith ,
T. Wykes ,
S. Rose ,
S. Enright ,
M. Hardcastle ,
S. Landau ,
M. F. Baksh  and
J. D. Gottlieb
...Show all authors
C. Steel*
Affiliation:
School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
A. Hardy
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
B. Smith
Affiliation:
North East London NHS Foundation Trust, UK
T. Wykes
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
S. Rose
Affiliation:
Berkshire Healthcare NHS Foundation Trust, UK
S. Enright
Affiliation:
Berkshire Healthcare NHS Foundation Trust, UK
M. Hardcastle
Affiliation:
Berkshire Healthcare NHS Foundation Trust, UK
S. Landau
Affiliation:
Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
M. F. Baksh
Affiliation:
Department of Mathematics and Statistics, University of Reading, Reading, UK
J. D. Gottlieb
Affiliation:
Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
D. Rose
Affiliation:
Health Services Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
K. T. Mueser
Affiliation:
Department of Mathematics and Statistics, University of Reading, Reading, UK
*
*Address for correspondence: C. Steel, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK. (Email: c.steel@reading.ac.uk)
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Abstract

Background

There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia.

Method

A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive–behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale.

Results

Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes.

Conclusions

The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.

Keywords

Cognitive–behavioural therapycognitive restructuringpost-traumatic stressrandomized controlled trialsschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 1 , January 2017 , pp. 43 - 51
Copyright
Copyright © Cambridge University Press 2016 

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References

Achim, AM, Maziade, M, Raymond, E, Olivier, D, Mérette, C, Roy, M (2011). How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophrenia Bulletin 37, 811–821.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text rev. American Psychiatric Association: Washington, DC.Google Scholar
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004). Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. British Journal of Psychiatry 185, 220–226.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA (1993). Beck Anxiety Inventory Manual. Harcourt Brace and Company: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for the Beck Depression Inventory, 2nd edn. The Psychological Corporation: San Antonio, TX.Google Scholar
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress 8, 75–90.Google ScholarPubMed
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669–673.CrossRefGoogle ScholarPubMed
Clark, DM, Ehlers, A (2004). Posttraumatic stress disorders from cognitive theory to therapy. In Contemporary Cognitive Therapy: Theory, Research, and Practice (ed. Leahy, RL), pp. 141–160. Guilford: New York.Google Scholar
de Bont, PA, van den Berg, DP, van der Vleugel, BM, de Roos, C, de Jongh, A, van der Gaag, M, van Minnen, A (2015). Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. British Journal of Psychiatry 206, 408–416.CrossRefGoogle ScholarPubMed
Foa, E (2008). Effective Treatments for PTSD, Second Edition: Practice Guidelines from the International Society for Traumatic Stress Studies. Guilford Press: New York.Google Scholar
Foa, EB, Ehlers, A, Clark, DM, Orsillo, SM, Tolin, DF (1999). The Posttraumatic Cognitions Inventory (PTCI): development and validation. Psychological Assessment 11, 303–314.CrossRefGoogle Scholar
Foa, EB, Hembree, E, Cahill, SP, Rauch, S, Riggs, DS, Feeny, NC, Yadin, E (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. Journal of Consulting and Clinical Psychology 73, 953–964.CrossRefGoogle ScholarPubMed
Gearon, JS, Bellack, AS, Tenhula, WN (2004). Preliminary reliability and validity of the Clinician-Administered PTSD Scale for Schizophrenia. Journal of Consulting and Clinical Psychology 72, 121–125.CrossRefGoogle ScholarPubMed
Green, BL (1996). Trauma History Questionnaire. In Measurement of Stress, Self-Report Trauma, and Adaptation (ed. Stamm, BH), pp. 366–368. Sidran Press: Lutherville, MD.Google Scholar
Grubaugh, AL, Zinzow, HM, Paul, L, Egede, LE, Frueh, BC (2011). Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clinical Psychology Review 31, 883–899.CrossRefGoogle ScholarPubMed
Haddock, G, McCarron, J, Tarrier, N, Faragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychological Medicine 29, 879–889.CrossRefGoogle ScholarPubMed
Hall, RC (1995). Global Assessment of Functioning. A modified scale. Psychosomatics 36, 267–275.CrossRefGoogle ScholarPubMed
Heinrichs, DW, Hanlon, TE, Carpenter, WT (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–398.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opfer, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Lataster, T, Valmaggia, L, Lardinois, M, Van Os, J, Myin-Germeys, I (2013). Increased stress reactivity: a mechanism specifically associated with the positive symptoms of psychotic disorder. Psychological Medicine 43, 1389–1400.CrossRefGoogle ScholarPubMed
Longden, E, Madill, A, Waterman, MG (2012). Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing. Psychological Bulletin 138, 28–76.CrossRefGoogle Scholar
Marks, I (1998). Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Archives of General Psychiatry 55, 317–325.CrossRefGoogle ScholarPubMed
Matheson, SL, Shepherd, AM, Pinchbeck, RM, Laurens, KR, Carr, VJ (2013). Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225–238.CrossRefGoogle ScholarPubMed
Meyer, JM, Farrell, NR, Kemp, JJ, Blakey, SM, Deacon, BJ (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy 54, 49–53.CrossRefGoogle ScholarPubMed
Morrison, AP, Renton, JC, Dunn, H, Williams, S, Bentall, RP (2003). Cognitive Therapy for Psychosis: A Case Formulation Approach. Psychology Press: Brighton.Google Scholar
Mueser, KT, Gottlieb, JD, Xie, H, Lu, W, Yanos, PT, Rosenberg, SD, Silverstein, SM, Duva, SM, Minsky, S, Wolfe, RS, McHugo, GJ (2015). Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. British Journal of Psychiatry 206, 501–508.CrossRefGoogle ScholarPubMed
Mueser, KT, Lu, W, Rosenberg, SD, Wolfe, R (2010). The trauma of psychosis: posttraumatic stress disorder and recent onset psychosis. Schizophrenia Research 116, 217–227.CrossRefGoogle ScholarPubMed
Mueser, KT, Rosenberg, SD, Xie, H, Jankowski, MK, Bolton, EE, Lu, W, Hamblen, JL, Rosenberg, HJ, Mchugo, GJ, Wolfe, R (2008). A randomized controlled trial of cognitive behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology 76, 259–271.CrossRefGoogle ScholarPubMed
Mueser, KT, Salyers, MP, Rosenberg, SD, Ford, JD, Fox, L, Carty, P (2001). Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychological Assessment 13, 110–117.CrossRefGoogle ScholarPubMed
O'Driscoll, C, Mason, O, Brady, F, Smith, B, Steel, C (2016). Process analysis of trauma-focused cognitive behavioural therapy for individuals with schizophrenia. Psychology and Psychotherapy: Theory, Research and Practice 89, 117–132.CrossRefGoogle ScholarPubMed
Picken, A, Tarrier, N (2011). Trauma and comorbid posttraumatic stress disorder in individuals with schizophrenia and substance abuse. Comprehensive Psychiatry 52, 490–497.CrossRefGoogle ScholarPubMed
Read, J, Fosse, R, Moskowitz, A, Perry, B (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry 4, 65–79.CrossRefGoogle Scholar
Resnick, SG, Bond, GR, Mueser, KT (2003). Trauma and posttraumatic stress disorder in people with schizophrenia. Journal of Abnormal Psychology 112, 415–423.CrossRefGoogle ScholarPubMed
Rose, S, Freeman, C, Proudlock, S (2012). Despite the evidence – why are we still not creating more trauma informed mental health services? Journal of Public Mental Health 11, 5–9.CrossRefGoogle Scholar
Rosenberg, SD, Mueser, K, Jankowski, M, Salyers, M, Acker, K (2004). Cognitive–behavioural treatment of posttraumatic stress disorder in severe mental illness: results of a pilot study. American Journal of Psychiatric Rehabilitation 7, 170–186.CrossRefGoogle Scholar
Schizophrenia Commission (2012). The Abandoned Illness: A Report by the Schizophrenia Commission. Rethink Mental Illness: London (https://www.rethink.org/media/514093/TSC_main_report_14_nov.pdf). Accessed August 2016.Google Scholar
Sin, J, Spain, D (2016). Psychological interventions for trauma in individuals who have psychosis: a systematic review and meta-analysis. Psychosis. Published online 23 May 2016. doi:10.1080/17522439.2016.1167946.Google Scholar
Smith, B, Steel, C, Rollinson, R, Freeman, D, Hardy, A, Kuipers, E, Bebbington, P, Garety, P, Fowler, D (2006). The importance of traumatic events in formulation and intervention in cognitive behavioural therapy for psychosis: three case examples. In Trauma and Psychosis: New Directions for Theory and Therapy (ed. Larkin, W and Morrison, AP), pp. 239–258. Routledge: Hove.Google Scholar
Steel, C (2015). Hallucinations as a trauma-based memory: implications for psychological interventions. Frontiers in Psychology 6, 1262.CrossRefGoogle ScholarPubMed
Steel, C, Fowler, D, Holmes, EA (2005). Trauma-related intrusions and psychosis: an information processing account. Behavioural and Cognitive Psychotherapy 33, 139–152.CrossRefGoogle Scholar
Switzer, GE, Dew, MA, Thompson, K, Goycoolea, JM, Derricott, T, Mullins, SD (1999). Posttraumatic stress disorder and service utilization among urban mental health center clients. Journal of Traumatic Stress 12, 25–39.CrossRefGoogle ScholarPubMed
Tarrier, N, Pilgrim, H, Sommerfield, C, Faragher, B, Reynolds, M, Graham, E, Barrowclough, C (1999). A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 67, 13–18.CrossRefGoogle ScholarPubMed
van den Berg, DPG, de Bont, PAJM, van der Vleugel, BM, de Roos, C, de Jongh, A, Van Minnen, A, van der Gaag, M (2015). Prolonged exposure v. eye movement desensitization and reprocessing v. waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry 72, 259–267.CrossRefGoogle ScholarPubMed
van der Gaag, M, Valmaggia, LR, Smit, F (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophrenia Research 156, 30–37.CrossRefGoogle ScholarPubMed
Weathers, FW, Keane, TM, Davidson, JR (2001). Clinician-Administered PTSD Scale: a review of the first ten years of research. Depression and Anxiety 13, 132–156.CrossRefGoogle Scholar
Wykes, T, Steel, C, Everitt, B, Tarrier, N (2008). Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin 34, 523–537.CrossRefGoogle ScholarPubMed